Poor Nutritional Status among Low-Income Older Adults: Examining the Interconnection between Self-Care Capacity, Food Insecurity, and Depression



      Understanding of the mechanisms of how food insecurity and poor physical and mental health status are interrelated with nutritional status among older adults is needed due to their unique health and social needs.


      To examine the complex relationships between self-care capacity, depressive symptoms, food insecurity, and nutritional status among low-income older adults.


      The cross-sectional study was conducted from February 2017 to May 2017.


      A total of 372 low-income older adults, 60 years of age and older, living in the state of Alabama participated.

      Main outcome measures

      Participants completed a validated survey measuring food insecurity (six-item US Food Security Survey Module), self-care capacity (Self-Care Capacity Scale), depressive symptoms (10-item Geriatric Depression Scale), and nutritional status (Mini Nutritional Assessment Short-Form).

      Statistical analyses performed

      Generalized structural equation modeling was used to include the simultaneous equations and multiple mediators in one model. The Akaike Information Criterion, Bayesian Information Criterion, and likelihood ratio tests were conducted to compare the fit of competing model specifications.


      Lower self-care capacity was associated with greater food insecurity (beta [b]=.11, odds ratio [OR]=1.11, P=0.03) and higher depressive symptoms (b=.08, P=0.005). Poorer self-care capacity and higher depressive symptoms were associated with poorer nutritional status (b=.24, OR=1.27, P<0.001; b=.13, OR=1.43, P=0.001, respectively). Higher food insecurity was associated with increased depressive symptoms (b=.40, P<0.001). Self-care capacity was associated with nutritional status directly and indirectly through depressive symptoms (b=.04, P=0.048). Although food insecurity was not significantly associated with nutritional status, a significant indirect association between food insecurity and nutritional status through depressive symptoms was observed (b=.02, P=0.04).


      Study results indicate functionally impaired low-income older adults encounter greater food insecurity. Inability to afford food combined with limited ability to take care of oneself contributes to an increased self-report of depressive symptoms, resulting in less favorable nutritional status.


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      S. E. Jung is an assistant professor, Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa.


      S. Kim is an assistant professor, Department of Sociology, Texas State University, San Marcos.


      A. Bishop is an associate professor, Department of Human Development and Family Sciences, Oklahoma State University, Stillwater.


      J. Hermann is a professor, Department of Nutritional Sciences, Oklahoma State University, Stillwater.